Vocera's Expanding Mobile Health Care Services for Smartphones

Unless you work in and around hospitals, or have been a patient at a growing list of facilities that have embraced the Vocera Communication platform, or perhaps stayed at a high-end hotel like the Trump SoHo, there's a good chance that Vocera is not a brand you know about. But if you were to visit one of these high-end hotels, or the 600 or so hospitals around the world that have built the Vocera platform into their communications workflow, you'd see their unique speech-enabled, wearable Wi-Fi device in use. The experience is not unlike the Star Trek communicator.

The iconic 4-inch-high badge is either clipped to clothing or worn with a lanyard and has no keypad, but rather the sender uses one large interface button to summon the Vocera genie to trigger both simple and complex communications. On the receiving end of an internally placed call, the user responds with simple voice commands or enters into conversation with the originating party.

While the Vocera badge remains the primary means of user interaction, recent shifts in their platform signal a much more diverse and open ecosystem that is interoperable with iPhones, Blackberrys and IP PBXs, with only more diversity to come.

With this new diversity quickly emerging, I reached out to Vocera Communications President and COO Brent Lang to catch up on Vocera's latest developments and to get a peek at their roadmap to see how it will impact telehealth, mobile health care and other businesses.

Kenny Schiff: The Vocera communication portfolio seems to be growing exponentially. With the release of the Vocera Smartphone last fall and the new apps coming for the iPhone and Blackberry there appears to be rapid diversification that we hadn't seen before. Why don't you tell us a little bit about the evolution and what led you to that?

Brent Lang: One of the things we learned through our experience in the marketplace is that depending on what your job was inside of the hospital, the device you carried varied quite a bit. Different people inside of a hospital had different requirements.

What we heard time and time again from our customers was that they loved the Vocera functionality. They loved being able to reach someone by their role or to be able to broadcast to a whole group of people. But that many of them have different requirements in terms of the end-point device. And at the end of the day, we're primarily a solutions company.

Most of our intellectual property and a lot of the functionality of our system actually reside in a software application that runs on a server, and is largely independent of what the end-point client device happens to be. So for us, it was a natural extension of our product strategy to extend the Vocera platform to a range of different devices because the command and control capabilities of the system are actually in the software.

So we've supplemented the Vocera badge with the Vocera Smartphone which provides the full Vocera functionality in a traditional phone form factor. It's a Wi-Fi phone. We've also ported the Vocera experience to run on Windows mobile devices like the Motorola MC70 and the Motorola MC55.

We are also expanding the Vocera experience to run on devices that are outside the hospital like iPhones and Blackberry devices. And we've even opened up what we call Vocera Access Anywhere, which allows any phone, a desk phone or a cell phone, to call into the Vocera system and take advantage of certain aspects of the functionality, even when the user is off campus.

Kenny Schiff: One of the things that differentiated Vocera from the very beginning was the badge. And for a lot of customers, and especially end users, Vocera is synonymous with the badge. And the thing about the badge is its simplicity. It's a total unique user experience centered around hands free and one central button. How well is that translating to the Smartphone or the apps that you might be developing?

Brent Lang: You're correct that many people associate the Vocera with the badge. I think it's a very iconic look and shape, and it's easily recognizable. In a photograph, even 100 yards down the hallway you can easily tell it's a Vocera badge. And for the most part, many of the clinicians inside of a hospital really appreciate the hands-free nature of the Vocera badge, because they're working with their hands as they interact with patients, or interact with medications, or other equipment.

What we've found though is that certain groups of users want to have access to a larger screen. One of the advantages of the Vocera Smartphone is that it has a high color, large high-resolution screen that allows customers to run other applications in addition to the Vocera.

It's a Windows Mobile platform, and they can run enterprise applications and even clinical applications. There's a full browser on the device as well. So, for example a hospitalist, a doctor who's located within the hospital that wants to be able to access email or calendar information, or access other clinical applications, he or she can take advantage of the screen. What we did in order to maintain the simplicity of the user interface is that we have a dedicated button on the side of the phone. It's an orange Vocera button, and when you press that button it completely replicates the simplicity of the Vocera badge experience and all of the voice commands that you would normally use from the Vocera badge.

Kenny Schiff: You mentioned hospitalist. It's been my experience that nurses and support staff have been the primary users of Vocera in hospitals, but physicians not so much. With so much attention on EHR as part of the health care reform, it seems there are new opportunities for bringing doctors into the Vocera experience. So do physicians play into your Vocera Anytime Anywhere strategy?

Brent Lang: We found that in about 60 percent of our customers, the customer indicated that doctors, physicians, primarily hospitalists were using the Vocera badge as well. Radiology, the emergency room doctors and other groups were also jumping on to the Vocera system. So it's actually expanded quite a bit beyond just the nursing group. What we find is that nurses want to be able to reach a physician in order to get approval for a drug administration or to notify them of a change of condition of a patient.

Using Vocera with Blackberrys, iPhones

Kenny Schiff: The interesting thing about doctors as a group is that they sometimes have a direct affiliation with a hospital. Sometimes they have multiple affiliations. They may not be employed by the hospital. These are people that may be roaming inside and outside of the enterprise. So to make an application like Vocera truly useful to them, it needs to move with them as they move in and out of what is ultimately an extended enterprise. I am wondering how you guys are thinking about that going forward?

Brent Lang: What we've done is we've actually introduced client applications that run on the Blackberry and iPhone that provides one touch connections back into the Vocera system from anywhere, whether they're inside the hospital or outside the hospital, at their clinic, or in their car. And the one-touch capability enables them to issue a full range of different commands: Call by name, call by role or broadcast, or check their messages or change their forwarding options. Same as they would be if they happened to be inside the hospital wearing their badge.

We've created the opportunity with the iPhone and the Blackberry to actually allow doctors to be associated with up to four different hospitals and be connected to the Vocera system for that particular hospital, and be logged in and be a user on those systems.

Kenny Schiff: The interesting thing about moving Vocera outside of the building and on to other devices is that it begs comparison for a lot of people to the other applications that they're used to. And of course you chose to call the Vocera handset a smartphone and for people that conjures up visions of iPhones and Droids. Do you consider the consumerization of the application based handsets to be a benefit or a hindrance to you? A lot, a lot of people are carrying Blackberrys, iPhones, Android devices. Is that good for Vocera?

Brent Lang: We consider it a very good thing. The more intelligence and device capability that's out there in the hands of potential users, the better we're able to extend the ecosystem and improve communication for customers. At the end of the day, the problem we're trying to solve is a lack of communication that's occurring between groups of clinicians inside of a hospital environment. One of the things that's happened over the last 10 or 15 years as more and more technology has come into the hospital, is that the human connection that used to exist between doctors and nurses, and doctors and patients, and nurses and patients has been to some extent replaced by generic and sterile interactions with computer terminals and electronic medical records. And the live human connections between those people have been pushed aside.

If you think about it historically, as a nurse and a doctor would be talking regularly about a particular patient, now a nurse is putting information into the electronic medical record. A doctor is reading those notes, and interacting with the patient. And we believe we have the opportunity to restore some of that human connection, by allowing these people to talk real time in live conversation. So to the extent that more and more doctors are carrying smartphones that can participate in the Vocera system, it improves the overall patient experience. Now nurses can get faster responses back, and they can treat patients more quickly. They can spend more time at the bedside and less time running around looking for other people.

We're very excited about it and we're fully embracing these other smartphone devices. We know that a company of our size will never be able to keep up with the rate of new product introduction that someone like RIM or Apple is able to do with their devices. But we believe that with our software capability, we can develop and run on our application server, and then port it out to these various devices is a much more effective way for us to continue to ride that evolution curve and take advantage of some of the innovations that companies like Apple are pushing into the marketplace.

And ultimately customers are interested in consolidating devices. So, to the extent that we can participate on the device of choice for these users, all the better. Now having said all that what we found in the marketplace is that for the employees of the hospital, the customers want to have a device that they own and operate. They don't want to have to keep track of devices that are owned and operated by their employees that are different security mechanisms and that kind of thing, and the nurses absolutely prefer having a hands-free device.

Vocera beyond mobile health care

Kenny Schiff: As late as last year, you had reported that 90 percent of your customers were in health care. Is it your destiny to serve the hospital market better or do you see increased diversification into other markets?

Brent Lang: We continue to look at other marketplaces. But I have to tell you that the problem that we're solving, and the solution we're delivering in the health care market is so compelling that we continue to get more and more interest and excitement from the health care marketplace. I think the answer to your question is both. We will continue to pursue other vertical markets but the business in the health care market is exploding for us right now and as a result it's hard to keep the percentage in the other markets up. It's just because of the percentage of our business in health care market that's growing much more quickly.

The value proposition in other vertical markets is a little bit more complex. There's typically not as many mobile workers as there are in hospitals. And as a result, while we continue to make good progress in some of those other markets, they're not as large. We have gotten good traction in the library market. We've gotten good traction in the hospitality market. We're looking at some of the energy marketplaces with power plants and things like that. But right now with such focus on health care, and a focus on efficiency and an increased focus on patient experience inside of hospitals, we expect that the health care market will continue to be our primary market.

How Vocera complements PBX

Kenny Schiff: Voice communications in the business enterprise traditionally has had the PBX at its centerpiece, and the key players like Avaya, Nortel, Cisco, Siemens, and NEC that have had a tremendous impact and are central to how businesses communicate. With more and more features and device diversity, is Vocera a disruptor or a complementary player to the PBX folks?

Brent Lang: We view ourselves as very complimentary to the PBX folks. We integrate very directly with the PBXs. One of the new pieces of product functionality that we shipped in Q2 of this year was a Vocera SIP telephony gateway which allowed for a direct connection to an IP PBX using the SIP protocol.

And what that did was actually improve the call quality associated with calls being placed from the Vocera system out to the public telephone network and to extensions off of the IP PBXs because it was an entirely IP based connection. So latency was reduced, call quality was increased. And Vocera's goal is not to try and replace or remove the PBX inside of these enterprise environments. PBX serves a very different function from what Vocera's trying to do. We view it very much complementary.

The presence information about them is really what, what's driving us. It's interesting, with the, increasing emphasis on text messaging and other forms of messaging people are stopping and asking the question, what is the value proposition of real time voice conversation?

I think the key for us is that we bring so much presence information to the conversation that when you need to have a lot of conversation with someone who can assist you, you're automatically being routed to the most appropriate person. One of the criticisms of voice conversations in the past is that they didn't have any presence information that allowed you to know whether the person you were reaching was truly ready to be reached or whether they were even the right person to be speaking to. And a big part of what Vocera is all about is capturing that presence information in terms of is the person you are calling available? Are they able to help you, are they currently in another call, or are they in a situation where they need to be routing that call to someone else? And really at the heart of the Vocera system is all that intelligence that's making sure you get to the right person. We see that as really a compliment or a set of features that exists, collectively with the PBX and doesn't compete directly with it.

Kenny Schiff: We talked about the PBX, which handles in-building voice communications and connectivity to the outside world. What about carriers? Now that you're moving into a domain that's not purely in-building, can you comment on your relationship with carriers and what kind of evolution might be going on in that regard?

Brent Lang: Right now we're, we're being fairly agnostic with regards to the carriers, because we're just operating over standard telephony protocols. And so, we can operate on any carrier's network and we haven't done anything that's specific to a particular carrier. We're leveraging the data networks that are associated with 3G connections down to the smartphones and we're also leveraging the traditional cellular phone connections back into the Vocera server. For the most part those are independent of particular carriers.

Kenny Schiff: It's 10 years since Vocera was founded and eight since the product first shipped. You've been at the company for most of that time so you've seen a lot of changes. Looking back is there anything that's really surprised you in regards to the evolution of the market or the product?

Brent Lang: I think the thing that surprised me the most is the original vision of the founders remains true through all that time and through all that evolution. When Vocera was founded we weren't clear on what markets we were going to primarily focus on, and yet the concept of the product with the wearable badge, based on voice commands and the capabilities of the workflow that were a part of the founders' original vision have stayed very much true to form.

The interesting thing that's evolved is that to some extent, the market has moved towards us. The amount of attention that's being placed on instant messaging and presence-based calling and the level of visibility on the importance of communication in hospitals has really played right into the value proposition that the founders of the company originally came up with.

We're feeling very bullish about the direction we've taken. The interesting thing is that as Wi-Fi and cellular networks have evolved, that's made our lives a lot easier. It used to be that we had our biggest struggle was making sure that the wireless network was sound and ready for voice communications. Most enterprise organizations today recognize that the wireless in an absolute necessity and are making the investment in their Wi-Fi infrastructure, and carriers with their cellular infrastructure. Having those networks in place and having them able to carry IP traffic has really leveraged our capability and made it easier for us to penetrate large organizations.

We think that in the hospital market that the communications problem is the biggest problem that needs solving. We feel like we're the company that's positioned the best to be able to do that. We're getting tremendous response from the relationships that we've built with our customers.

Kenny Schiff is a contributor to Internet.com's EnterpriseMobileToday.com. He is also the founder and president of TPC Healthcare, a specialty provider of real-time location and point-of-care communication technologies to hospitals and health care organizations.

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